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DocuSign Envelope ID: 1 FB3C60F-686F-4434-8500-FE7D2516331 E <br /> 11 <br /> FALL 2016 <br /> ir Cv <br /> ORANGE COUNTY ARTS <br /> ARTS IN EDUCATION GRANT <br /> COMMISSION APPLICATION FORM <br /> 1. APPLICANT INFORMATION <br /> A pp li cant Name C v � Ivi Pn-t() r1- &-LIOO ( P <br /> Mailing Address ) 9 9 5 E ��s(1(s U1n u. k > y A C 2.7- j -1 <br /> Daytime Phone (6116) 1'2°1- 3-t 5 Email Address pre c,J Teo , he gs p+CC, C <br /> Web Site in) ( , el011LSv1.S*1° 4--o`'` DUNS Number I 00H03 Li Se) <br /> li <br /> 2. PROJECT DIRECTOR INFORMATION <br /> Project Director Name K � ) E- <br /> f�S e,Y\ �� �A Title U i Cc Pie- ( e + ' 0" <br /> Home Address: II ( N6 e_ C�� d [ I I J� 24-5 / T 1 <br /> I <br /> Daytime Phone (dlt't) C 1 '1 — Li U Evening Phone 5cc'1 c <br /> Email 14J,;deA 60kC I.A►'t'iai i f , r_ovv. DUNS Number I bp L(O,3 L{ S O <br /> 3. GRANT REQUEST SUMMARY <br /> Arts Program Grant Request $ 1000 , O 0 Total Cash Match $ 1000. 00 <br /> Total Organizational Budget Past Year S 3 5C2, 00 r <br /> (Including PTSA/Cultural Current Year 4( 1) -i- O2 <br /> 1 ?- <br /> Enrichment/Arts Program) Projected for Next Year ,i '5 ! 0 0[2 C 0 0 <br /> Summary Statement for Proposed Uses of Arts Program Grant: I (n@. Er• x,t5 C(Q Y & wo( <br /> PTA is re desfi ' 1(000.00 -4-0 10e nc I� 7.5d o c'wM 4 is <br /> nA 10 „ 40 1��� Ac,, .Ast- ..�.s ,� 20t6--)- 17 y,sk,- J.„..--1- -,- st <br /> 4. NARRATIVE Peek '�a� Sk��-+-b b� Ge.e,n . <br /> Write a description (no more than three pages,single spaced)that describes the following under <br /> separate subheadings: <br /> • School profile—a brief overview of population and services. <br /> • School's arts programs—a brief list. <br /> • Proposed uses of grant funds—description, including location, date, artists involved. Include <br /> information concerning whether you have undertaken similar activities in the past. Include <br /> approximate number of audience per program;geography of audience; mix of race, ethnicity, <br /> age, and gender. Discuss how arts program will be integrated into the curriculum. <br /> 919 245 2335 ( 200 S.Cameron Street,Hillsborough,NC 27278 I www.ortsorange.org <br />